Any plans the Minister has to review and, if necessary, update the proposals for reform of health and social care services set out in P.82/2012, lodged on 11th September 2012

2018.09.25

5.5  Senator S.C. Ferguson of the Minister for Health and Social Services regarding any plans the Minister has to review and, if necessary, update the proposals for reform of health and social care services set out in P.82/2012, lodged on 11th September 2012: [OQ.133/2018]

What plans does the Minister have to review and, if necessary, update the proposals for the reform of health and social care services set out in P.82/2012, lodged on 11th September 2012?

The Deputy of St. Ouen (The Minister for Health and Social Services):

I thank the Senator for her question. My department is working hard and rapidly to review the progress on P.82 and plan for the delivery of more services under that proposal because the principles to deliver safe, sustainable care closer to home, supporting people living healthier lives, are still as important as they ever were.

1. Senator S.C. Ferguson:

P.82 is quite specific in that it asked for proposals to develop a new model of primary care and it also... it asked for a new hospital, yes, but it also asked for a new model of primary care and proposals for a sustainable funding mechanism for health and social care, and it was asking for them in 2014. Will the Minister explain why we have not had them yet?

The Deputy of St. Ouen :

There are a number of services that we now have which did not exist in 2012. They include Jersey Talking Therapies, community midwives, rapid response and reablement, step-up step-down, oxygen service, pulmonary rehabilitation; there is work being carried out on the development of multidisciplinary teams centred on patients. My Assistant Minister, Deputy Raymond, and I had the privilege recently of visiting the Child Development and Therapy Centre at Overdale where they now work as multidisciplinary teams rather than having separate speech and language and physiotherapy departments, each of which their clients have to attend. The services are wrapped around a child and one person, among all the professionals, is appointed as the contact for the child. It was an excellent step forward and that sort of development is being planned throughout the health service. Thank you.

2. Senator S.C. Ferguson:

Yes, but there are a number of technical advances which have not been available through the Health and Social Services Department and one of the most important things is the sustainable funding mechanism, particularly for primary care with doctors. That is the one that is really missing and we were meant to have it by 2014; where is it?

The Deputy of St. Ouen :

Yes, both the Senator and I will know the debates that occurred in the last Assembly around a health charge, which I did not support. Perhaps she did not support, I cannot recall. So there is still that huge issue that will face this Assembly on how to meet the increasing costs of healthcare because it is true, as we will all be aware, that these costs generally outstrip inflation and we want to deliver a safe and efficient service to the residents of the Island. It is fair to say that perhaps that issue has still to be resolved, exactly what sustainable funding looks like. But in respect of primary care, it is the plan to, again, make primary care just the doorway into a seamless service to patients and a more integrated part of the whole health service. There is much that is happening at the moment, there are some excellent discussions taking place with primary care practitioners who are keen to build a sustainable system working closely with the department, particularly in areas such as dermatology and diabetes, mental health and respiratory services.

[10:15]

Discussions are ongoing and I hope, in just a few months, we will be able to report publicly on new initiatives. Thank you.

3. Deputy G.P. Southern :

The Minister just made reference to mental health as a priority area and talked about seamless provision of services. Does he not accept that his provision is woefully lacking in the essential factor that delivers good health which is staffing? The answers he gives to my written question 10 reveal that one in 6 nursing posts are currently vacant in mental health. One in 8 specialist doctors' posts are vacant and 10 per cent of therapists' posts are also vacant. Does he not accept this is a woeful record currently in place and what measures has he got in hand to improve this lamentable situation?

The Deputy of St. Ouen :

Yes, it is a challenge to recruit to mental health services. The Deputy has quoted the contents of the written answer and the number of vacancies that exist in the establishment posts but that is not to say that those posts are not filled because many of them are filled by bank nurses or agency nurses or locums, so the service is being provided to the extent that we can, though of course they are significant pressures and we would love to have a secure recruitment. As the Deputy knows, there are many issues, one of which is the accommodation of key workers. Others relate to nursery provision for families moving here, which is something I am presently trying to find out more about; how can we staff and fund a nursery provision so it is not a block to retaining good staff here in the Island. But it is a challenge shared across the Council of Ministers how we retain our key workers and work is being done to address those as soon as we can.

4. Senator K.L. Moore :

In a previous answer the Minister referred to the debate around a health charge. I would ask the Minister to reassure the Assembly that he will bring a renewed enthusiasm to the work to deliver a sustainable funding mechanism for primary care, which was not the point of the health charge. As Senator Ferguson has said, the sustainable funding mechanism was agreed by a previous Assembly to have been implemented in 2014 and it is way, way behind.

The Deputy of St. Ouen :

I thank the Senator for her question. The whole Council of Ministers is clear about the need to address the issue around primary care and its sustainability and its funding, particularly to make it completely available to vulnerable groups. It is the intent of the Council of Ministers to bring forward proposals to address that. It is equally my intent too, and I have seen that in the last term, the difficulties around our primary care system. I have met primary care practitioners who are anxious to reform the way they work and overcome this issue, and work with the health and community services to provide that integrated service. I believe there is change and a will for change within the professions. It is difficult because they are independent professions. We have a limited control over people who run independent businesses so we must bring them with us and they must equally share the vision for the Island. But I believe so many of them do and I can confirm that they are talking to us in that sort of way and I believe we will make progress and be able to announce initiatives, I really hope, very soon. Thank you.

5. Deputy M. Tadier :

Following up from written question 10 about mental health services, can the Minister tell us how the vacancy rates in Jersey for mental health compare with those in the U.K.?

The Deputy of St. Ouen :

On an oral question I cannot descend into the detailed comparisons of vacancy rates between jurisdictions. But it is known that all jurisdictions have a challenge to recruit mental health staff, no less so in the U.K. I think that is the best I can do at the moment.

6. Deputy G.P. Southern :

Does the Minister accept that the reliance on bank nurses and locums is not sustainable or practical in the long term just merely on the basis that such employees cost more than having proper placements; and does he accept, and will he share with his fellow Members of the Council of Ministers, that we can no longer rely on a low-tax low-spend model to provide for the needs of our population? That has to change. In the light of the recent question from Deputy Ward about 80 per cent of States workers having pay awards below the R.P.I., does he not think that is also linked to the absence or the dire need for us to rely on bank nurses and locums to provide our health service?

The Deputy of St. Ouen :

I think there were 3 huge questions in there.

The Bailiff :

They were really huge questions, Minister, and I could tackle 2 of them.

The Deputy of St. Ouen :

There will always be a need for some locums and some bank staff, and indeed many of our staff do value the opportunity to work on the bank. It is perhaps the over-reliance on them that causes the difficulty because teams cannot be built when people are in the workforce as locums or agency staff. So, that is the difficulty. I am sure there will always be such posts filled by locums, et cetera. I am unable to commit the Council of Ministers as to a move from a low-tax low-spend system, if that is indeed the correct description of our system, but the Council of Ministers, as I have said, is very well aware of the pressures surrounding health costs and is anxious and is working to try and address these issues.

The Bailiff :

This is a good example of a question time turning into a debate. The question was a very broad question: "Will the Minister review and update proposals?" His answer is basically yes but I think you have asked it in a number of different areas. It is not an opportunity for a debate about the whole of the health service which would be too wide and too unstructured. Deputy Tadier , you had one further question then I am going to have the final supplementary from Senator Ferguson.

Deputy M. Tadier :

Thank you, Sir, I do not need to ask it.

7. Senator S.C. Ferguson:

I rather thought we were a low-tax high-spend jurisdiction but that is another story. Will the Minister undertake to return to the States with a progress report on parts (b)(ii) and (iii) of P.82 preferably by Easter?

The Deputy of St. Ouen :

Yes, I would certainly hope to report to the States by Easter and hopefully before, so I undertake to do so.